Who is to Blame for Resident’s Legal Battle with Her Program?

Our blogger, Skeptical Scalpel, recently wrote about a surgical resident’s legal battle with her program, which highlights a surgical resident who is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training.

The article has generated a lot of different opinions and comments online, coming from a wide range of professionals in the medical field.

To add some background on this topic, the resident had been placed on academic probation at the end of her third year because of poor test scores on the American Board of Surgery In-Service Training Examination (ABSITE). Other residents with poor scores were not subjected to the same disciplinary action.

During her fourth year of residency, written evaluations by faculty were generally very good, but some oral feedback she received was negative. However, she received no specific recommendations for improving her performance. In fact, she contends that attendings on some services filed no written evaluations at all which is contrary to the regulations of the Accreditation Council for Graduate Medical Education—the national organization that oversees all residency training in the United States. She says some backdated written evaluations appeared in her file.

The resident, a nurse before attending medical school, was told she acted too much like a nurse by the residency program director, who is a woman, and the male trauma chief said she was “too nice” to be a surgeon. Too nice to be a surgeon? That’s a serious accusation. We can’t have that.

The resident appealed the program’s decision to the hierarchy of the medical school to no avail. Meanwhile, the Post-Dispatch reported that St. Louis University has sued the resident and her husband for “diluting SLU’s brand by using the institution’s trademarked name on a website the pair created.”

How should this situation be handled moving forward? Here are some of the comments we came across:

“It seems the only concrete finding against her would be the in training exam scores but if other classmates did just as poorly or worse without academic probation her program sounds like it’s out to get her.”

“Academic Orthopod chiming in. I’ve had this situation with one of our residents. For any program to even consider this usually means that the resident in question has been screwing up consistently for a while, and with many things – not just test scores. It’s such a tremendous burden for any program to do this – we know that it will go to a lawsuit – they always do. It also screws up the training schedule, call schedule, etc – no one considers this without significant cause.”

“Sounds like the program was being lazy, and even if their concerns were justified, they did not properly keep track of her performance nor did they provide her with feedback that she could use to improve her performance.

Residents, especially struggling residents, deserve better than this. You and the program have invested time, but don’t forget that the resident has invested time as well.”

“It’s never a good look to have a long time of normal evals and then suddenly a string of negative ones leading to a repeated year. Usually this falls into one of a few categories:

1. The resident has really bad habits in her interactions with coworkers, either lazy or gunner, but does so in ways that aren’t part of official record. Meaning that any accusations of such by faculty are their word against hers (hence their reluctance to put that down on official record until they know for sure the other faculty will back them up).

2. The resident clashes personally with the faculty or chiefs over non-medical issues so much that they look for any excuse to discourage her from the field. In this case, that excuse was her poor testing performance.

3. The resident has a good attitude but not quite as good mental or physical skills as her co-residents, so the faculty try to help her along with positive official reviews and private feedback to improve until they just can’t make excuses for her anymore. Which isn’t to say she’s being ungrateful; it is a disservice to let someone think they’re doing ok when they’re really not.”

“Quite frankly the old school way of doing it was to take the resident into the back room and say “you ain’t cutting it, you’re fired,” or “you have to do another year.” Surgeons take it very seriously to put their name on a candidate that they wouldn’t let operate on their own family (which BTW used to be the shorthand for a competent graduate). Some programs are having trouble with the modern requirements for documentation and will need to get it together, but quite frankly I think the old method had a lot of merit. If at the end of the day I as an attending surgeon wouldn’t feel comfortable letting a graduate operate on someone I liked it should mean something. A program director still has to sign an affadavit that affirms that the resident is qualified to be a surgeon. If I’m required to sign off on them, how is it that a failure to document a good reason to sign a false statement?”

“Doctors need to get with the times. Nowadays everything is so easy to do electronically. You’re literally clicking a radio button “always sometimes never” pick a score from 0-10. Documentation is important. I had a patient go nuts on me and I documented the heck out of all our interactions and had my MA document all the phone calls. Sure enough she sent a complaint to the medical board, and all I had to do was send them my notes to prove there was no merit. “Because I said so” doesn’t fly any more and it only pisses people off when we dig our heels in harder and act like rules are different in the medical world.”